- CVS Health (Albany, NY)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Humana (Albany, NY)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- Cognizant (Albany, NY)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical … more
- CVS Health (Albany, NY)
- … (UM) Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all ... and state regulated turn-around times. This includes reviewing written clinical records. **Key Responsibilities of the UM Nurse...practice experience as an RN required. + 2+ Years Utilization Management experience. + Must be willing… more
- CVS Health (Albany, NY)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in XXX zones **Education**… more
- CVS Health (Albany, NY)
- …with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management opportunity for RNs with a **New York** state licensure. ... 8:30am - 5pm EST. This role is a registered nurse that utilizes MCG rules and applies medical necessity...unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of clinical… more
- CDPHP (Latham, NY)
- …required as a Registered Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims processing is ... of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review...transportation, DME requests and inpatient readmissions. In collaboration with management , the UR nurse identifies potentially high-cost… more
- CVS Health (Albany, NY)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- CVS Health (Albany, NY)
- … skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable in ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years post… more
- Trinity Health (Troy, NY)
- …differences often lead to innovative solutions. **Registered Nurse Professional Utilization Management Nurse - St. Peter's Hospital--Full-TIme Days** ... and shifts to accommodate all schedules **What you will do:** + Perform utilization management , both concurrent and retroactive for inpatient and outpatient… more
- CDPHP (Latham, NY)
- …care experience in a hospital setting required. + Minimum one (1) year quality/ utilization management experience in health care setting preferred. + Experience ... CDPHP headquarters. Qualifications: + Licensed Master Social Worker, Licensed Clinical Social Worker, or Licensed Mental Health Counselor (Valid...with utilization management software including Facets, Macess and… more
- Evolent (Albany, NY)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more
- Sharecare (Albany, NY)
- …helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- New York State Civil Service (Albany, NY)
- …Hearing Detection and Intervention (EHDI) Program. The candidate will provide program management and clinical oversight of public health program planning, ... care organization, or private physician's office is also considered non qualifying. Clinical / management experience providing maternal child health services, or … more
- Ellis Medicine (Niskayuna, NY)
- …in performance improvement/research activities; maintains professional practice standards and clinical expertise; and demonstrates leadership skills. The Nurse ... Basic Function: The Nurse Manager (NM) actualizes the vision, mission and...population served. This position is accountable for maintaining all clinical administrative functions (patient care delivery, fiscal, material and… more
- Molina Healthcare (Albany, NY)
- …recommendations for denial or modification of payment decisions. * Serves as a clinical resource for utilization management , chief medical officers, ... the payment Integrity analytical team; makes decisions and recommendations pertinent to clinical experience. * Facilitates document management , clinical … more
- CVS Health (Albany, NY)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Trinity Health (Schenectady, NY)
- …preferred or obtained within 2 years of hire. + Previous experience in nurse management required Our compassionate staff is there with up-to-the-minute treatment ... stroke, traumatic injury or disabling illness. **Full Time Registered Nurse (RN) - Manager - Sunnyview Rehab Hospital -...30 out of 1100+ rehab hospitals has a wonderful management opportunity! We at St. Peter's Health Partners recognize… more
- Trinity Health (Albany, NY)
- …Cardiology Office - Albany, NY - FT - Days** If you are looking for a Clinical Nurse Manager position in an Outpatient Cardiology practice, this could be your ... allowance and career development **What you will do:** The Nurse Manager of Clinical Care is directly...well as appropriate governmental and other regulatory standards. Insures clinical management presence during working hours. +… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- …education, orientation, competencies and providing quality improvement and enhance outcomes utilization . This nurse integrates knowledge, skills, abilities, and ... EDRP participants ineligible to apply. Responsibilities The Inpatient Staff Registered Nurse (RN) is responsible for providing competent, evidence-based care to… more